MSN 622 FINAL EXAM 2026 UPDATE QUESTIONS
AND CORRECT VERIFIED ANSWERS ALREADY
GRADED A+ (BRAND NEW VISION)
A 75-year-old male presents with a complaint of palpitations for the past 1 week. He denies any
associated symptoms. He has a past medical history of hypertension and diabetes mellitus type
2, for which he takes lisinopril and metformin at home. He smokes 1 pack of cigarettes per day
and drinks 1-2 beers daily. On physical exam, his blood pressure is 158/90 mmHg, his pulse is
irregularly irregular with a rate of 110/min, his respirations are 16/min, his temperature is
99.4°F (37.4 °C), and his pulse oximetry is 97% on room air. A rhythm strip from his examination
is provided. A complete blood count (CBC) and thyroid function tests are normal. A bedside
echocardiogram shows no structural abnormalities. Which of the following treatments is most
appropriate at this time to prevent adverse effects from his arrhythmia? - ANS-Apixaban
A 59-year-old female with a past medical history of coronary artery disease, hypertension,
hyperlipidemia, obesity, gastroesophageal reflux disease, and alcohol dependence presents to
the emergency department with acute onset shortness of breath for one day. She has dry cough
and nausea. Vitals shows heart rate of 138/min, respiratory rate 32/min, temperature 99 F, and
blood pressure is 142/92 mmHg. Oral mucosa is dry, and her breath smells of alcohol. Lungs
exam reveals fine bibasilar crackles and the neck exam is unremarkable. Also, the EKG shows an
irregularly irregular rhythm. Labs indicate a raised blood alcohol level and TSH is 0.36 mU/L.
Diltiazem infusion is initiated along with fluids. Which of the following is the best management
plan for this patient? - ANS-Continue diltiazem drip, IV fluids, and consult cardiology
A 65-year-old woman with claudication symptoms for the last six months presents to the clinic
for evaluation. The patient has a history of diabetes and hypertension. She denies smoking.
Physical exam shows palpable pulses on the bilateral lower extremities. Ankle-brachial index
done at bedside shows a 1.1 on the right and 1.0 on the left lower extremity. What is the next
best step in the management of this patient? - ANS-Repeat ankle-brachial index after exercise
A 65-year-old man presents with palpitations and dyspnea without chest pain or
lightheadedness. His medical history is significant for hypertension and hyperthyroidism. A 12-
,lead ECG is shown below. What is the mechanism of this patient's arrhythmia? - ANS-Micro-
reentry
A 65-year-old man presents to the emergency department with chest pain, palpitations, and
dyspnea. The client has a past medical history significant for hypertension and hyperthyroidism.
An electrocardiogram (EKG) is performed, as shown in the figure. Initial medical management is
initiated. Which of the following is the most appropriate initial objective of this patient's
treatment? - ANS-Decrease the ventricular rate below 100/min
A 65-year-old man presents to the emergency department with palpitations, lightheadedness,
and chest discomfort. He has a history of hypertension and mitral stenosis. His vital signs
include a heart rate of 141/minute, blood pressure of 110/78 mm Hg, and oxygen saturation of
97% on room air. A 12-lead electrocardiogram is shown. Which of the following best describes
the rate of atrial activity associated with this patient's condition? - ANS-More than 350/minute
A 45-year-old man presents for a two-month history of worsening dyspnea. He denies a history
of fever and sore throat with joint pain during childhood. On examination, he is found to have
displaced, thrusting apex beats and a systolic murmur. His echocardiographic images are shown
below. What is the definitive management for this patient's condition? - ANS-Mitral valve repair
or replacement
A 65-year-old man presents with complaints of palpitation, dizziness, and dyspnea for the past 2
hours. The patient has a past medical history significant for hypertension, diabetes mellitus, and
hyperthyroidism. An electrocardiogram (ECG) is shown. After initial stabilization, the patient is
discharged with a Holter monitor and asked to return after 7 days. At his next visit, ECG tracings
show similar findings as seen on his first visit. The patient's condition can be classified as which
of the following? - ANS-Persistent atrial fibrillation
A 65-year-old man presents with complaints of palpitations, dyspnea, and chest discomfort. The
patient has hypertension and diabetes mellitus. His blood pressure is 140/90 mmHg, heart rate
120/min, and respiratory rate 23/min. An electrocardiogram is performed, which is shown in
the image. Which of the following valvular diseases is associated with this patient's condition? -
ANS-Mitral stenosis
, A 75-year-old man with a history of hypertension presents to the emergency department with
dizziness, lightheadedness, and palpitations that started this morning. He reports occasional
palpitations at home while climbing stairs or doing heavy work, but these episodes do not last
more than a few minutes. His blood pressure is 95/70 mm Hg, heart rate 125 bpm, respiratory
rate 22 breaths/min, and oxygen saturation 95% on room air. The physical examination findings
are unremarkable. An electrocardiogram is negative for ST-segment changes or T-wave
abnormalities. A rhythm strip is shown below. What is the best next step in the management of
this patient? - ANS-Intravenous fluid bolus followed by intravenous metoprolol
What is the most appropriate goal while treating a patient with atrial fibrillation? - ANS-To
reduce the ventricular response rate below 100 beats/minute
A 65-year-old man presents with an enlarging, painless thyroid nodule. Laboratory testing
shows an elevated thyroid stimulating hormone level and a positive anti-thyroid peroxidase and
anti-thyroglobulin antibodies. Histological exam shows dense lymphoplasmacytic infiltrate with
the formation of lymphoid follicles. What is this patient at risk for developing? - ANS-Lymphoma
A 67-year-old woman is newly diagnosed with type 2 diabetes mellitus. Her blood pressure is
above 140/90 mmHg on 3 separate occasions, 2 weeks apart. Laboratory tests show a BUN of
15 mg/dL, creatinine of 1.1 mg/dL, and spot urine microalbumin of 100 mcg/mg creatinine.
Which of the following medications would be most appropriate? - ANS-Angiotensin-converting
enzyme (ACE) inhibitor
A patient is admitted with acute appendicitis. He is to receive nothing by mouth (NPO). The
patient says, "I am supposed to take glyburide 5 mg by mouth daily." His glucose level on
admission is 362 mg/dlL He is to receive 10 units of regular human insulin subcutaneously
without delay. Which of the following explanations should be given to the patient? - ANS-
Subcutaneous insulin is only temporary while the patient is NPO.
A 55-year-old woman presents to the clinic for a follow-up. Her past medical history is
significant for hypertension and type 2 diabetes mellitus. She is currently taking lisinopril and
metformin. She reports feeling well and exercising 3-4 times per week. She has changed her diet
AND CORRECT VERIFIED ANSWERS ALREADY
GRADED A+ (BRAND NEW VISION)
A 75-year-old male presents with a complaint of palpitations for the past 1 week. He denies any
associated symptoms. He has a past medical history of hypertension and diabetes mellitus type
2, for which he takes lisinopril and metformin at home. He smokes 1 pack of cigarettes per day
and drinks 1-2 beers daily. On physical exam, his blood pressure is 158/90 mmHg, his pulse is
irregularly irregular with a rate of 110/min, his respirations are 16/min, his temperature is
99.4°F (37.4 °C), and his pulse oximetry is 97% on room air. A rhythm strip from his examination
is provided. A complete blood count (CBC) and thyroid function tests are normal. A bedside
echocardiogram shows no structural abnormalities. Which of the following treatments is most
appropriate at this time to prevent adverse effects from his arrhythmia? - ANS-Apixaban
A 59-year-old female with a past medical history of coronary artery disease, hypertension,
hyperlipidemia, obesity, gastroesophageal reflux disease, and alcohol dependence presents to
the emergency department with acute onset shortness of breath for one day. She has dry cough
and nausea. Vitals shows heart rate of 138/min, respiratory rate 32/min, temperature 99 F, and
blood pressure is 142/92 mmHg. Oral mucosa is dry, and her breath smells of alcohol. Lungs
exam reveals fine bibasilar crackles and the neck exam is unremarkable. Also, the EKG shows an
irregularly irregular rhythm. Labs indicate a raised blood alcohol level and TSH is 0.36 mU/L.
Diltiazem infusion is initiated along with fluids. Which of the following is the best management
plan for this patient? - ANS-Continue diltiazem drip, IV fluids, and consult cardiology
A 65-year-old woman with claudication symptoms for the last six months presents to the clinic
for evaluation. The patient has a history of diabetes and hypertension. She denies smoking.
Physical exam shows palpable pulses on the bilateral lower extremities. Ankle-brachial index
done at bedside shows a 1.1 on the right and 1.0 on the left lower extremity. What is the next
best step in the management of this patient? - ANS-Repeat ankle-brachial index after exercise
A 65-year-old man presents with palpitations and dyspnea without chest pain or
lightheadedness. His medical history is significant for hypertension and hyperthyroidism. A 12-
,lead ECG is shown below. What is the mechanism of this patient's arrhythmia? - ANS-Micro-
reentry
A 65-year-old man presents to the emergency department with chest pain, palpitations, and
dyspnea. The client has a past medical history significant for hypertension and hyperthyroidism.
An electrocardiogram (EKG) is performed, as shown in the figure. Initial medical management is
initiated. Which of the following is the most appropriate initial objective of this patient's
treatment? - ANS-Decrease the ventricular rate below 100/min
A 65-year-old man presents to the emergency department with palpitations, lightheadedness,
and chest discomfort. He has a history of hypertension and mitral stenosis. His vital signs
include a heart rate of 141/minute, blood pressure of 110/78 mm Hg, and oxygen saturation of
97% on room air. A 12-lead electrocardiogram is shown. Which of the following best describes
the rate of atrial activity associated with this patient's condition? - ANS-More than 350/minute
A 45-year-old man presents for a two-month history of worsening dyspnea. He denies a history
of fever and sore throat with joint pain during childhood. On examination, he is found to have
displaced, thrusting apex beats and a systolic murmur. His echocardiographic images are shown
below. What is the definitive management for this patient's condition? - ANS-Mitral valve repair
or replacement
A 65-year-old man presents with complaints of palpitation, dizziness, and dyspnea for the past 2
hours. The patient has a past medical history significant for hypertension, diabetes mellitus, and
hyperthyroidism. An electrocardiogram (ECG) is shown. After initial stabilization, the patient is
discharged with a Holter monitor and asked to return after 7 days. At his next visit, ECG tracings
show similar findings as seen on his first visit. The patient's condition can be classified as which
of the following? - ANS-Persistent atrial fibrillation
A 65-year-old man presents with complaints of palpitations, dyspnea, and chest discomfort. The
patient has hypertension and diabetes mellitus. His blood pressure is 140/90 mmHg, heart rate
120/min, and respiratory rate 23/min. An electrocardiogram is performed, which is shown in
the image. Which of the following valvular diseases is associated with this patient's condition? -
ANS-Mitral stenosis
, A 75-year-old man with a history of hypertension presents to the emergency department with
dizziness, lightheadedness, and palpitations that started this morning. He reports occasional
palpitations at home while climbing stairs or doing heavy work, but these episodes do not last
more than a few minutes. His blood pressure is 95/70 mm Hg, heart rate 125 bpm, respiratory
rate 22 breaths/min, and oxygen saturation 95% on room air. The physical examination findings
are unremarkable. An electrocardiogram is negative for ST-segment changes or T-wave
abnormalities. A rhythm strip is shown below. What is the best next step in the management of
this patient? - ANS-Intravenous fluid bolus followed by intravenous metoprolol
What is the most appropriate goal while treating a patient with atrial fibrillation? - ANS-To
reduce the ventricular response rate below 100 beats/minute
A 65-year-old man presents with an enlarging, painless thyroid nodule. Laboratory testing
shows an elevated thyroid stimulating hormone level and a positive anti-thyroid peroxidase and
anti-thyroglobulin antibodies. Histological exam shows dense lymphoplasmacytic infiltrate with
the formation of lymphoid follicles. What is this patient at risk for developing? - ANS-Lymphoma
A 67-year-old woman is newly diagnosed with type 2 diabetes mellitus. Her blood pressure is
above 140/90 mmHg on 3 separate occasions, 2 weeks apart. Laboratory tests show a BUN of
15 mg/dL, creatinine of 1.1 mg/dL, and spot urine microalbumin of 100 mcg/mg creatinine.
Which of the following medications would be most appropriate? - ANS-Angiotensin-converting
enzyme (ACE) inhibitor
A patient is admitted with acute appendicitis. He is to receive nothing by mouth (NPO). The
patient says, "I am supposed to take glyburide 5 mg by mouth daily." His glucose level on
admission is 362 mg/dlL He is to receive 10 units of regular human insulin subcutaneously
without delay. Which of the following explanations should be given to the patient? - ANS-
Subcutaneous insulin is only temporary while the patient is NPO.
A 55-year-old woman presents to the clinic for a follow-up. Her past medical history is
significant for hypertension and type 2 diabetes mellitus. She is currently taking lisinopril and
metformin. She reports feeling well and exercising 3-4 times per week. She has changed her diet
